A Performance Test to Assess Strategies to Transfer Weight During Knee Flexion and Extension With Rotation for Individuals With a Total Knee Replacement

2012 ◽  
Author(s):  
Lauren Ferris ◽  
Linda Denney ◽  
Lorin Maletsky
Keyword(s):  
Total Knee Replacement ◽  
Knee Replacement ◽  
Performance Test ◽  
Knee Stability ◽  
Vertical Projection ◽  
Single Plane ◽  
Flexion Extension ◽  
Weight Shift ◽  
Total Knee ◽  
Supporting Base

Stability has been defined as the ability to transfer the vertical projection of the center of gravity to the supporting base and keep the knee as still as possible1. The transfer of weight (load) to a single limb while still in double-stance is functional and simulates every day activities such as loading the dishwasher, transferring laundry, or reaching to pick up an item. Adding rotation in a transverse plane to this weight shift challenges knee stability, especially those with a total knee replacement (TKR). A clinical sign of laxity in mid-flexion indicates a risk for developing symptomatic instability; a common reason for TKR revision2. Laxity is usually measured clinically in a single plane (anterior-posterior) and functionally with added turning maneuvers. Single-leg weight acceptance has been analyzed during athletic activities such as hopping, landing with cutting as well as in the older population with stair ascent and descent3–5. Although single-leg performance tests are a good indicator of knee stability, weight shift during double-stance may be more functional for individuals with a TKR. A functional double-stance test should include both flexion/extension with rotation and loading. Our study utilizes a novel approach (Target Touch Task) in order to facilitate transfer of load to one extremity during squatting or extending while still in double-stance. The objective of this study was to identify strategies utilized by individuals with a TKR while in double-stance transferring load during rotational activities.

scholarly journals Knee Flexion and Daily Activities in Patients following Total Knee Replacement: A Comparison with ISO Standard 14243

2015 ◽  
Vol 2015 ◽  
pp. 1-7 ◽  
Author(s):  
Markus A. Wimmer ◽  
William Nechtow ◽  
Thorsten Schwenke ◽  
Kirsten C. Moisio
Keyword(s):  
Total Knee Replacement ◽  
Knee Replacement ◽  
Knee Flexion ◽  
Daily Activities ◽  
Wear Testing ◽  
Significant Difference ◽  
Flexion Extension ◽  
Total Knee ◽  
Stair Walking ◽  
The Many

Walking is only one of many daily activities performed by patients following total knee replacement (TKR). The purpose of this study was to examine the hypotheses (a) that subject activity characteristics are correlated with knee flexion range of motion (ROM) and (b) that there is a significant difference between the subject’s flexion/extension excursion throughout the day and the ISO specified input for knee wear testing. In order to characterize activity, the number of walking and stair stepping cycles, the time spent with dynamic and stationary activities, the number of activity sequences, and the knee flexion/extension excursion of 32 TKR subjects were collected during daily activity. Flexion/extension profiles were compared with the ISO 14243 simulator input profile using a level crossing classification algorithm. Subjects took an average of 3102 (range: 343–5857) walking cycles including 65 (range: 0–319) stair stepping cycles. Active and passive ROMs were positively correlated with stair walking time, stair step counts, and stair walking sequences. Simulated knee motion according to ISO showed significantly fewer level crossings at the flexion angles 20–40° and beyond 50° than those measured with the monitor. This suggests that implant wear testing protocols should contain more cycles and a variety of activities requiring higher knee flexion angles with incorporated resting/transition periods to account for the many activity sequences.

Evaluation of the relationship of tibiofemoral kinematics before and after total knee replacement in an in vitro model of cranial cruciate deficiency in the dog

2016 ◽  
Vol 29 (06) ◽  
pp. 484-490 ◽  
Author(s):  
Rebecca Howie ◽  
Timothy Foutz ◽  
Curtis Cathcart ◽  
Jeff Burmeister ◽  
Steve Budsberg
Keyword(s):  
Total Knee Replacement ◽  
Knee Replacement ◽  
External Rotation ◽  
Cruciate Ligament ◽  
Flexion Extension ◽  
Before And After ◽  
Total Knee ◽  
Tibiofemoral Kinematics ◽  
The Relationship

SummaryObjective: To investigate the relationship between tibiofemoral kinematics before and after total knee replacement (TKR) in vitro.Animals: Eight canine hemipelves.Methods: A modified Oxford Knee Rig was used to place cadaveric limbs through a range of passive motion allowing the kinematics of the stifle to be evaluated. Four measurements were performed: a control stage, followed by a cranial cruciate transection stage, then following TKR with the musculature intact stage, and finally TKR with removal of limb musculature stage. Joint angles and translations of the femur relative to the tibia, including flexion-extension versus adduction-abduction, flexion-extension versus internal-external rotation, as well as flexion-extension versus each translation (cranial-caudal and lateral-medial) were calculated.Results: Significant differences were identified in kinematic data from limbs following TKR implantation as compared to the unaltered stifle. The TKR resulted in significant decreases in external rotation of the stifle during flexion-extension compared to the limb prior to any intervention, as well as increasing the abduction. The TKR significantly increased the caudal translation of the femur relative to the tibia compared to the unaltered limb. When compared with the cranial cruciate ligament-transection stage, TKR significantly decreased the ratio of the external rotation to flexion.Discussion: All three test periods showed significant differences from the unaltered stifle. The TKR did not completely restore the normal kinematics of the stifle.

Accuracy of single-plane fluoroscopy in determining relative position and orientation of total knee replacement components

2011 ◽  
Vol 44 (4) ◽  
pp. 784-787 ◽  
Author(s):  
Stacey Acker ◽  
Rebecca Li ◽  
Heather Murray ◽  
Paul St. John ◽  
Scott Banks ◽  
...  
Keyword(s):  
Total Knee Replacement ◽  
Knee Replacement ◽  
Relative Position ◽  
Single Plane ◽  
Total Knee ◽  
Position And Orientation

Quantification ofin vivoimplant wear in total knee replacement from dynamic single plane radiography

2013 ◽  
Vol 58 (9) ◽  
pp. 2751-2767 ◽  
Author(s):  
Matthew G Teeter ◽  
Petar Seslija ◽  
Jaques S Milner ◽  
Hristo N Nikolov ◽  
Xunhua Yuan ◽  
...  
Keyword(s):  
Total Knee Replacement ◽  
Knee Replacement ◽  
Single Plane ◽  
Total Knee

scholarly journals Comparison of the Kinematics Following Gait Perturbation in Individuals Who Did or Did Not Undergo Total Knee Replacement

2021 ◽  
Vol 11 (16) ◽  
pp. 7453
Author(s):  
Vicktoria Elkarif ◽  
Leonid Kandel ◽  
Debbie Rand ◽  
Isabella Schwartz ◽  
Alexander Greenberg ◽  
...  
Keyword(s):  
Total Knee Replacement ◽  
Knee Replacement ◽  
Plantar Flexion ◽  
Joint Kinematics ◽  
Gait Velocity ◽  
Timed Up And Go ◽  
Flexion Extension ◽  
Risk Of Falls ◽  
Total Knee ◽  
One Year

We aimed to compare the spatiotemporal parameters and joint kinematics during unperturbed and perturbed gait between individuals with osteoarthritis (OA) who did or did not undergo total knee replacement (TKR) one year post a baseline evaluation. OA subjects scheduled for TKR (TKR group; n = 14) and not scheduled for TKR (NTKR group; n = 17) were age-matched. Outcome measures included: joint range of motion, timed up and go, joint pain levels, Oxford score, and the Activities-specific Balance Confidence Scale. In addition, spatiotemporal gait parameters and joint kinematics were recorded during perturbed and unperturbed gait. After one year, most of the TKR group (71%), but only 41% of the NTKR group, increased their gait velocity by more than 0.1m/sec, which is the meaningful clinical important difference for gait velocity. After perturbation of the contralateral limb, the TKR group showed a greater decrease in the maximal extension of the OA hip compared to the NTKR group (p = 0.031). After perturbation of the OA limb, more subjects decreased their OA knee flexion–extension range in the NTKR group compared to the TKR group (p = 0.011) and more subjects decreased their maximal ankle plantar flexion in the TKR group (p = 0.049). Although the surgery was successful in terms of pain reduction and increased functionality, individuals following TKR exhibited unique compensatory strategies in response to the perturbation of both limbs. These findings might suggest that balance deficits remain in individuals following TKR and therefore are associated with a risk of falls.

Total Knee Replacement Polyethylene Stresses During Loading in a Knee Simulator

2000 ◽  
Vol 123 (4) ◽  
pp. 842-847 ◽  
Author(s):  
Virginia L. Giddings ◽  
Steven M. Kurtz ◽  
Avram A. Edidin
Keyword(s):  
Total Knee Replacement ◽  
Knee Replacement ◽  
Tibial Component ◽  
Joint Kinematics ◽  
Knee Simulator ◽  
Flexion Extension ◽  
Total Knee ◽  
Von Mises ◽  
Anterior Posterior ◽  
Bumper System

We investigated the stresses and kinematics of a total knee replacement during the duty cycle of a knee simulator. Finite element models were constructed of the tibial and the femoral component of a commercially available cruciate retaining total knee replacement. Time dependent flexion/extension, axial loading, and anterior/posterior loading were applied to the components of the arthroplasty to match those generated by the knee simulator. We evaluated the effect of varying the stiffness of a spring-loaded bumper system for anterior-posterior constraint on the joint kinematics as well as on the stresses within the polyethylene tibial component. Both the joint kinematics and the stresses and strains subjected to the polyethylene tibial component, were found to be comparatively insensitive to the stiffness of the spring bumper system for this design. When the stiffness of the bumper system was increased by two orders of magnitude, the maximum contact stresses, von Mises stresses, and von Mises strains in the polyethylene tibial component varied by only 15 to 59 percent. In general, increasing the stiffness of the bumper system decreased the displacements of the base plate, but the relationships were nonlinear, possibly due to the added constraints imposed by the tibiofemoral contact interaction. The long-term goal of this research is to develop a validated structural model to predict the stresses, kinematics, and ultimately, the wear, of total joint replacement components in a contemporary knee joint simulator.

scholarly journals Home-Based versus Hospital-Based Rehabilitation Program after Total Knee Replacement

2015 ◽  
Vol 2015 ◽  
pp. 1-9 ◽  
Author(s):  
Remedios López-Liria ◽  
David Padilla-Góngora ◽  
Daniel Catalan-Matamoros ◽  
Patricia Rocamora-Pérez ◽  
Sagrario Pérez-de la Cruz ◽  
...  
Keyword(s):  
Muscle Strength ◽  
Total Knee Replacement ◽  
Knee Replacement ◽  
Treatment Effectiveness ◽  
Controlled Trial ◽  
Rehabilitation Program ◽  
Joint Mobility ◽  
Home Based ◽  
Flexion Extension ◽  
Total Knee

Objectives. To compare home-based rehabilitation with the standard hospital rehabilitation in terms of improving knee joint mobility and recovery of muscle strength and function in patients after a total knee replacement.Materials and Methods. A non-randomised controlled trial was conducted. Seventy-eight patients with a prosthetic knee were included in the study and allocated to either a home-based or hospital-based rehabilitation programme. Treatment included various exercises to restore strength and joint mobility and to improve patients’ functional capacity. The primary outcome of the trial was the treatment effectiveness measured by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC).Results. The groups did not significantly differ in the leg side (right/left) or clinical characteristics (P>0.05). After the intervention, both groups showed significant improvements (P<0.001) from the baseline values in the level of pain (visual analogue scale), the range of flexion-extension motion and muscle strength, disability (Barthel and WOMAC indices), balance, and walking.Conclusions. This study reveals that the rehabilitation treatments offered either at home or in hospital settings are equally effective.

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